青光眼顽固性高眼压的分期手术治疗

Staging operation in the treatment of refractory glaucoma

目的:分析青光眼顽固性高眼压状态下,先行睫状体光凝术降低部分眼压,Ⅱ期行进一步抗青光眼手术治疗的临床疗效观察。方法:回顾性分析北京华德眼科医院2013-01/2014-07收治的青光眼顽固性高眼压患者临床资料,共30例30眼,其中女12例,男18例,平均年龄56岁。这30眼中,急性闭角型青光眼急性发作期2眼,晶状体过熟期4眼,晶状体膨胀期6眼,新生血管性青光眼5眼,抗青光眼术后眼压仍不能控制正常9眼,玻璃体切除术后继发性青光眼4眼。所有患者入院后均首选睫状体光凝术,如果眼压未控制,则根据患者病情再行Ⅱ期抗青光眼手术。结果:在我们随访过程中,30例30眼均获得了满意效果,术前平均眼压62.79±5.59mmH g,一次睫状体光凝术后,眼压均有不同程度的下降,术后1wk,眼压降至32.84±8.16mmH g,其中6例完全控制正常,其余24例Ⅱ期再行进一步抗青光眼手术,术后眼压正常,术中无一例并发症出现。结论:青光眼顽固性高眼压状态下,先行睫状体光凝术控制眼压,可以大大减少二次手术时并发症的出现,后根据患者原发病的个体差异,Ⅱ期行进一步抗青光眼手术是一种安全有效的分期联合手术方式。

AIM：To analyze the clinical results of cyclophotocoagulation followed by other anti-glaucoma surgeries in the treatment of refractory glaucoma.METHODS：The clinical data of 30 patients（30 eyes）with refractory glaucoma were retrospectively analyzed from January 2013 to July 2014 in Beijing Huade Hospital,including 12 females and 18 males,with an average age of56 years.Among the 30 eyes,there were 2 eyes with acute angle- closure glaucoma,4 eyes with over mature cataract,6 eye with intumescent cataract,5 eyes with neovascular glaucoma,9 eyes with hard-to-controlled glaucoma even after surgeries,4 eyes with secondary glaucoma after vitrectomy.Diode laser transscleral cyclophotocoagulation was applied to all patients as the primary choice.If the intraocular pressure（IOP） was not well controlled,a secondary anti-glaucoma surgery was applied.RESULTS：During the follow-up period,all of the 30 eyes had satisfactory results,with no complications during or after the operations.The average pre-operative IOP was 62.79±5.59 mmHg,which dropped to 32.84±8.16 mmHg at 1wk after cyclophotocoagulation.Six of 30 eyes had totally normal IOP,the rest 24 cases underwent another anti-glaucoma operation,after which the IOP decreased to a normal range and in which no complication occurred.CONCLUSION：In the treatment of refractory glaucoma,applying cyclophotocoagulation first to control the IOP can greatly reduce risk of complications during the secondary surgeries.According to their original categories,further anti-glaucoma surgery can reduce the IOP to a safe and effective range.